Theses and Dissertations

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Browsing Theses and Dissertations by Author "ABEYAGUNAWARDENE, LND"

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    A Study of some factors influencing the high defaulter rate among leprosy patients in the Western Province of Sri Lanka
    (Post Graduate Institute of Medicine, Colombo: PGIM ., 1985) ABEYAGUNAWARDENE, LND
    Although non compliance with recommended treatment regimens is a problem that often crops up in the case of most chronic illnesses, it is particularly so in the case of chronic diseases sucha s leprosy which require long periods of uninterrupted treatment. Failure on the part of patients to attend clinics regularly, which are conducted specifically for the purpose of medical examination of patients and distribution of prescribed drugs, makes case holding one of the major problems in the leprosy control programme. In this study, an attempt has been made to find out the reasons for non-acceptance of treatment services and to ascertain what factors affect the decision making process of the patients. Although this complex problem warrants a full scale investigation to cover a complete spectrum of psycho-socio-cultural factors, medical factors and service factors, the contrasting nature of each group of factors, calls for the use of a different research methodology to cover each group. The present study is confined to the medical factors and some of the demographic factors which can conveniently be covered through a quantitative analysis of patients' clinic records. Due to certain operational constraints, the study area is restricted to the Western Province of Sri Lanka which has the highest prevalenvce of the disease and where more than 50 of all known cases are concentrated. A literature search revealed that a study of this nature had never been undertaken in Sri Lanka before, although a few studies on the problem of case holding in leprosy have been reported from elsewhere. This study includes a review of all available literature, not only on the subject of case holding in leprosy, but non-compliance with treatment regimens in general. 5681 files of all patients registered in 21 clinics in the Western Province were scrutinised. Of these, 4286 patients who remained on the register during the entire 2 year period from 1st January 1980 to 31st December 1981, were considered as eligible for the study. Data relating to the factors being studied (age, sex, marital status, place of residence, type of leprosy, degree of deformity etc.) were obtained from patients' clinic records and recorded using a suitable format. The clinic attendance history of each patient during the 2 year period was also recorded so that the degree to which each patient defaulted (kept away from clinics) could be expressed in quantitative terms. The data collected was processed and analysed by computer. The maim was to establish any significant association between each of the independent variables such as age, sex, marital status, type of leprosy, degree of deformity etc., and the degree or intensity of default, which was the dependent variable. Multiple regression analysis using the forward selection procedure was used as the statistical technique in carrying out the analysis. Of a total of 16 factors considered in this study, a significant association was established between 10 of them and the intensity or degree of default. They were: 1)Reactions 2)Place of residence 3)Duration of treatment 4)Degree of deformity 5)Activity 6)Family history 7)Duration of disease 8)Age 9)Marital status and 10)Efficiency of treatmet. Other factors namely: 1)Religion 2)Visibility of lesions 3)Type of leprosy 4)Race 5)Number of lesions and 6)Sex, did not have any significant association with the degree of default. The more significant finding however, was the fact that the above factors taken togenter accounred for only 17.22 of variance, implying that there are more important factors responsible for the high degree of default of patients. This finding indicates that the socio-cultural and service factors not covered in the present study may holf the key in explaining the balance 83.78 of variance. The significant association between some of the independent variables and the degree of default can be explained by the application of the Health Belief Model, which is an accepted theory in behavioural sciences. For instance, patients with severe deformities were found to attend clinic more regularly tha those who were not deformed. It is postulated that the patient gauges the severity of this illness by the degree of deformity, which prompts him to attend clinic regularly. On the other hand, the type of leprosy was not found to be an associated factor. rhis sounds logical because, the patient being a laymen, will not be able to differentiate between the different types of leprosy. The need for further research to examine the role of socio-cultural factors and service factors as contributory causes for the high rate of default, is clearly established. The need to focus attention on the providers of services and the service organisation, and not merely the community, in carrying out research of thid type, is particularly stressed. Suitable research methodologies to study these aspects are suggested.